Bioprosthetic aortic valve replacement in older patients ...

[Pages:9]CLINICAL RESEARCH

INTERVENTIONS FOR STRUCTURAL HEART DISEASE

AsiaIntervention 2015;1:72-80

Long-term clinical outcomes of mechanical versus bioprosthetic aortic valve replacement in older patients

Sung-Han Yoon1, MD; Jung-Min Ahn1, MD; Jihyun Song2, PhD; Young-Hak Kim1, MD; Cheol Whan Lee1, MD; Jong-Young Lee1, MD; Soo-Jin Kang1, MD; Duk-Woo Park1, MD; Seung-Whan Lee1, MD; Joon Bum Kim3, MD; Sung-Ho Jung3, MD; Cheol Hyun Chung3, MD; Suk Jung Choo3, MD; Seong-Wook Park1, MD; Jae Won Lee3, MD; Seung-Jung Park1*, MD

1. Division of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea; 2. Department of Statistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea 3. Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea

Sung-Han Yoon and Jung-Min Ahn contributed equally to this article.

KEYWORDS

? aortic valve replacement

? bioprosthetic valve ? mechanical valve

Abstract

Aims: To compare the long-term outcomes of mechanical valves as opposed to bioprosthetic valves in order to inform valve selection.

Methods and results: From January 1996 to December 2010, 561 patients aged 60 to 75 years undergoing AVR for the first time were evaluated (mechanical valve: N=251; bioprosthetic valve: N=310). The primary outcome was all-cause death, and secondary outcomes were reoperation, bleeding events, thromboembolism, endocarditis and major adverse prosthesis-related events (MAPE). MAPE were the composite of reoperation, bleeding, thromboembolism and endocarditis. Long-term outcomes were compared with the use of propensity scores to adjust for selection bias. After risk adjustment, both groups of patients showed a similar risk of death at 10 years (hazard ratio [HR] 1.25, 95% confidence interval [CI]: 0.85-1.85, p=0.26), reoperation (HR 2.94, 95% CI: 0.79-11.11, p=0.11) and thromboembolism (HR 0.38, 95% CI: 0.10-1.40, p=0.15). Compared with the patients given mechanical valves, those who received bioprosthetic valves were at a higher risk of endocarditis (HR 7.65, 95% CI: 1.74-33.52, p=0.007), but were, however, at a lower risk of bleeding (HR 0.25, 95% CI: 0.12-0.52, p ................
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